ω-3鱼油脂肪乳对重症急性胰腺炎早期全身炎症反应的调控：60例随机对照临床研究

Effects of ω-3 fish oil emulsion on systemic inflammatory response syndrome in the early phase of severe acute pancreatifls： randomized clinical trial for 60 patients

目的探讨ω-3鱼油脂肪乳对重症急性胰腺炎（SAP）患者早期全身炎症反应（SIRS）的调控作用。方法将60例SAP患者随机分为2组，每组30例。对照组（Con组）患者行常规治疗，鱼油组（F0组）辅以静脉给予0．2g／（kg·d）10％ω-3鱼油脂肪乳，观察两组患者早期急性生理和慢性健康评估Ⅱ评分、SIRS评分以及炎性因子的变化情况。结果FO组患者急性生理和慢性健康评估Ⅱ评分较Con组显著降低，治疗后第4天起与Con组分值差距显著增大（P〈0．05）；患者的液体负平衡出现时间（5．1±2．2）d较Con组（8．4±2．3）d显著缩短（P〈0．05）；SIRS评分显著减少，且于治疗后第4天起率先摆脱SIRS状态；血浆肿瘤坏死因子-α（TNF-α）的水平显著降低，而白介素-10（IL-10）的血浆水平显著升高，IL-10／TNF-α比值显著升高，治疗第4—7天最为显著（P〈0．05）。结论早期静脉运用ω-3脂肪酸鱼油乳能够有效降低SAP患者早期SIRS的反应强度和持续时间，纠正促／抗炎因子的失衡，改善患者严重的疾病状态，为SAP早期调控SIRS反应提供了新的、有效的手段。

Objective To evaluation the effects of parenteral supplementation with ω-3 fish oil emulsion on the systemic inflammatory response syndrome （SIRS） in the early phase of severe acute pancreatitis （SAP）. Methods Sixty patients with SAP were randomized either to treat with fish oil emulsion 0. 2 g/（ kg·d） （ FO group, n = 30） or conventional therapy （Con group, n = 30）, and the change of SIRS state were observed by acute physiology and chronic health evaluation Ⅱ （APACHE-Ⅱ ） scores, SIRS scores, and inflammatory eytokines. Results During observation, APACHE-Ⅱ scores in FO group were significantly lower, and the gap in- creased even larger after Day 4 （ P 〈 0. 05 ）. The negative fluid equilibrium time significantly decreased in FO group [ （5.1 ± 2.2 ） days ] compared with Con group [ （ 8.4 ± 2. 3 ） days ] （ P 〈 0. 05 ）, while SIRS scores significantly decreased and firstly went out the SIRS state on Day 4 after treatment. Compared with Con group, the plasma level of tumor necrosis factor-α （TNF-α） continuously significantly decreased, interleukin-10 （IL-10） sig- nificantly increased, and the ratio of IL-10/TNF-α significantly increased, which was most remarkable between Day 4 and Day 7 after treatment in FO group （ P 〈 0.05 ）. Conclusions Early parenteral supplementation with ω-3 fish oil emulsion can effectively reduced the magnitude and persistence of the SIRS, retrieve the unbalance of the pro-/anti-inflammatory, and improve the severe disease conditions. Therefore, it provides a new and feasible way to regulate SIRS in the early phase of SAP.